The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 22, 2007 #2,942 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Dante A. Cedrone, DPM

Dante A. Cedrone, DPM, 80, of Bonita Springs, FL, and Cranston, RI passed away May 10, 2007, at the Philip Hulitar Hospice Inpatient Center, Providence. He was the husband of Sadie (Oliveri) Cedrone. They would have celebrated 50 years of marriage in this year .

Dr. Dante A. Cedrone

Dr. Cedrone was a graduate of Providence College and the Chicago College of Podiatry. He practiced podiatry in Cranston for 32 years before his retirement in 1992. Dr. Cedrone was a member of the American Podiatric Medical Association and a past president of the R.I. Podiatry Society. An avid golfer, Dr. Cedrone was a longtime member of the Quidnessett and Pelican Nest country clubs.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation's Student Endowment Fund, 9312 Old Georgetown Rd., Bethesda, MD 20814.

Source: Cranston Herald [5/16/07]

Scholl ’s Dr. Armstrong Appointed to Illinois State Diabetes Commission

David G. Armstrong, DPM, PhD, Professor of Surgery and Director of Scholl College’s Center for Lower Extremity Ambulatory Research at Rosalind Franklin University in North Chicago , accepted an appointment this week to the Illinois State Diabetes Commission. As a newly appointed commissioner, he will actively participate in state-wide and national initiatives to promote diabetes awareness and improve diabetes care.

Dr. David Armstrong

The Illinois State Diabetes Commission was established in 2006 through Senate Bill 2483, and includes representation from the physician community, the American Diabetes Association, the Juvenile Diabetes Research Foundation, and members of the public who have been diagnosed with diabetes.

HIPAA Allows Police Access to Patients, Federal Judge Rules

HIPAA privacy rules do not bar law enforcement from having access to patients who are victims of alleged crimes, a Louisiana federal judge recently ruled. The decision affirmed that police had the right to arrest a hospital case worker for obstruction of justice when she tried to stop police from questioning a patient. The ruling likely will not embolden state authorities to barge into the treatment room, experts say.

Experts say the court's decision is consistent with the federal privacy statute. But they warn that a case like this can be a close call, and doctors should take note of the interplay between state and federal law. HIPAA does not pre-empt stricter state medical records privacy laws.

Philip H. Lebowitz, a HIPAA lawyer and partner with Philadelphia-based Duane Morris LLP recommended that to protect themselves, doctors should know their state laws and make a good-faith effort to first obtain patient consent. If law enforcement comes knocking, physicians can disclose limited medical information related to an alleged incident, he said. But if they aren't sure what is required of them, doctors can seek legal counsel and ask to see a legal request.

Source: Amy Lynn Sorrel, AMNews [5/21/07]

Query: Tibialis Anterior Tendon Tear

I have a 24 year old distance runner who developed sudden pain in the left midfoot during a routine run in March. An MRI indicates a localized longitudinal tear of the tibialis anterior tendon as it passes over the 1st cuneiform. This corresponds to the patient's clinical presentation. So far cast immobilization has not significantly reduced his symptoms. The patient has a supinated foot type and has been in the appropriate orthotic for many years. He also had surgery for subluxing peroneal tendons on the same side in December, 2004. Any thoughts on where to proceed from here?

David O'Brian, DPM, Roselle, IL

RE: Numbness in Athlete with Diabetes (Michael Zapf, DPM)
From: Multiple Respondents

This is a fairly common problem with athletes. While they are running, there is often impingement of the lateral branch of the superficial peroneal nerve at the distal fibula. This can also occur with other nerves, but I have found this nerve to be the most common. First, see if your patient can actually point to the spot of numbness, not just a description. Once you localize the general area, I would inject 1 cc. of lidocaine at the exact area of the nerve that you believe is involved. See if you can reproduce the numbness that he has during his run.

You may need to identify multiple nerves. Typically the mechanism is internal rotation of the tibia with abduction of the foot and this will cause the nerve entrapment laterally and eventually neuroma or neuritis. A gait analysis should make this pretty clear and then treatment with appropriate orthoses. Some patients may require an AFO to get more stability.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

I would look into functional syndromes such as anterior or posterior compartment syndrome or functional tarsal tunnel. These can be common in many atheletes but a diabetic may be more prone due to sorbitol build up in their nerves, causing intra neural swelling. The subsequent swelling of a normally tight compartment during exercise would exacerbate the pressure on the nerves.

Greg Mowen, DPM, Ventnor, NJ, gregmowen@comcast.net

If he is well controlled (and I assume that because he is), then I would look to a CCS (chronic compartment syndrome) and have compartment pressure performed on him by someone who does this regularly. It might also be a local entrapment of one of the peripheral nerves in which case it needs to be isolated and EMG are not always helpful. Careful history and exam of numb area will help. Have him seen after he runs to accomplish the former.

Peter J. Bregman, DPM, Woburn, MA, Footdoc@painfreefeet.com

This complaint is fairly common in runners who run 5-10 mile tracks. If he only gets the numbness at the time of running, then the usual cause for this is that he is buying running shoes without taking into account the extra expansion of the foot due to the pounding that goes on while doing this length of run. He needs to buy a running shoe a half size longer than usual, and an extra width wider. Additionally, he needs to wear a good running sock. He will find that in the first 3 miles, he has a little bit of extra room in the shoe that will automatically disappear on mile 3-4.

Itamar Rosenbaum, C.Ped., New York, NY, nycped@verizon.net

R/o tarsal tunnel caused by soft tissue mass over the posterior tibial nerve or its branches. Maybe also bicycle seat related sciatic nerve injury. This probably is not diabetic related.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: Free Diabetic Shoes (Robert Schwartz, C.Ped)
From: Joel Gluck, DPM

Regarding the ad in yesterday’s PM News, I am not sure what the problem is. Isn't this the same as a diabetic patient going to a shoe store, getting fitted for a pair of shoes, and purchasing them? Patients do not go shoe shopping with their doctor. They may have a doctor's Rx and guidelines given by the doctor. As long as the shoe store has a DME number, why shouldn't they be able to bill Medicare? The ad clearly says that "...you could be eligible for free shoes each year..." As far as I know, this is still a true statement. The ad also says that shoe sizing will occur which is normal in any shoe store. There is also blood glucose and pressure monitoring which could be performed by a nurse if they are present, and if they don't bill Medicare for the test, what is the harm in this? I just don't understand what the problem is other than it takes money out of our pockets. Based on this ad, I see poor taste (Old Country Buffet?), but not fraud.

Joel Gluck, DPM, Warwick, RI, jgluc1@aol.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

EQUIPMENT FOR SALE – SURGICAL SYSTEM / TOURNIQUET SYSTEM

1) Osada Pedo-30w-electric surgical system with drill handpiece and oscillating saw handpiece. Includes several blades, and sterilizable handpiece rests (2) $2100 plus shipping (9 lbs,6.6 ozs). 2) DELFI Medical P.T.S. tourniquet system. Does not include tourniquet $1500, plus shipping (4 lbs,4 ozs). Both in excellent condition. TEMDPM@CS.com or 814-237-3338.

FOR SALE - EQUIPMENT

Boyd chairs, mini x-ray floor unit, Konica developer, ultrasound,Ellman surgitron, Imex 9000, Ille whirlpool, viewboxes, SmartDop, topical oxygen units, office furniture, etc. cast saw, lakeside carts, parafin wax bath, hand instruments. Contact jhallux@yahoo.com or fax (703) 264-7745 for full list.

PRACTICE FOR SALE WASHINGTON, DC

Hospital based 25 y/o practice, Billing 400k/yr/gross 285+. Four tx rooms fully equipped. X-ray, US, THBO, vascular testing. Loyal patient base, Wound care, diabetes, all aspects of surgery. Hospital priviledges. Seller very motivated to move fast. Relocating - $125k (OBO). Contact jhallux@yahoo.com or fax: (703)264-7745.

PRACTICE FOR SALE : LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA

Associate leading quickly to Ownership Wonderful opportunity to join Kaiser trained podiatrist in a well established, ethical, full scope podiatric practice. Competitive compensation Most be BE/BC Send CV and references to: reversoman@aol.com

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

ASSOCIATE WANTED – NYC

.

Associate wanted for practice with offices in Queens and Manhattan. Applicant should be 2-3 year trained, ABPS certified/ eligible. All aspects of Podiatry from necessary routine care to reconstructive rearfoot surgery. Growth potential, partnership potential, benefits available, access to managed care contracts. Send CV to METROFOOTAPPS@aol.com
.

PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

.

EQUIPMENT FOR SALE: CRYOPROBE SYSTEM

.

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $12,000. This lists for $14,900. The CryoPac system comes complete with two fully sterilizable probes. This system has been used less than 15 times and can be used to treat plantar fasciitis, neuromas, and other foot pathology. E-mail serious inquires to: drsammendicino@gtef.org

.

.

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 9,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.